| NPI | 1952948820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8215) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC p16356) |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2019-12-10 |